Mastroroberto P, Chello M, Bevacqua E, Cirillo F, Covino E
Department of Experimental and Clinical Medicine, University of Catanzaro, Catanzaro, Italy.
Can J Cardiol. 2000 Oct;16(10):1269-72.
The Edwards-Duromedics (ED) is a bileaflet pyrolitic carbon mechanical valve introduced by Hemex Scientific Inc in 1982, subsequently acquired by Baxter Healthcare Corp, withdrawn from the market in 1988, and modified and reintroduced in 1990. From 1982 to date, 46 cases of leaflet escape have been registered by the manufacturer of an estimated total of 20,000 valves implanted. Disc embolization 12 years after an ED mitral prosthesis implantation is reported in a 45-year-old man operated on when he was in cardiogenic shock because a preliminary transthoracic Doppler echocardiography did not show malfunction of the valve. A correct diagnosis was made four days after the onset of the symptoms by transesophageal echocardiography. During the operation, the posterior leaflet of the ED valve was not found, a 29 mm St Jude Medical bileaflet mechanical prosthesis was implanted and the patient died in the intensive care unit because of low cardiac output syndrome. Cavitation damage is generally considered the most frequent mechanism in cases of such fracture. Thus, any patient with a mechanical valve presenting with acute pulmonary edema must be immediately transferred to a surgical unit; cinefluoroscopy or transesophageal echocardiography may be performed rapidly to achieve successful management of patients with leaflet embolization.
爱德华兹-杜罗梅迪克斯（ED）瓣膜是一种双叶热解碳机械瓣膜，由Hemex Scientific Inc于1982年推出，随后被百特医疗保健公司收购，1988年退出市场，并于1990年经过改良后重新推出。从1982年至今，该瓣膜制造商已记录到46例瓣叶脱落病例，估计总共植入了20000枚瓣膜。本文报告了一名45岁男性患者，在植入ED二尖瓣假体12年后出现瓣片栓塞，该患者在因心源性休克接受手术时，初步经胸多普勒超声心动图未显示瓣膜功能异常。症状出现四天后，经食管超声心动图做出了正确诊断。手术过程中，未发现ED瓣膜的后叶，植入了一枚29毫米的圣犹达医疗双叶机械假体，患者因低心输出量综合征在重症监护病房死亡。空化损伤通常被认为是此类骨折最常见的机制。因此，任何出现急性肺水肿的机械瓣膜患者都必须立即转至外科病房；可迅速进行荧光透视或经食管超声心动图检查，以成功处理瓣叶栓塞患者。
